This document provides guidance from an infectious diseases physician on various clinical scenarios including:
- Consult service responsibilities and guidelines
- Common infections such as pneumonia, urinary tract infections, intra-abdominal infections, and neutropenic fever
- Workups and empiric antibiotic recommendations for different infections
- Notes on specific pathogens like C. difficile, MRSA, and issues around reported penicillin allergies
The document aims to help clinicians efficiently diagnose and treat common infections at the institution.
Presentation on Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis
References:
American Academy of Pediatrics. Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis, 2013.
American Academy of Pediatrics. Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis, 2012.
Pneumonia in pregnancy april2018 pmm_aogsParthiv Mehta
Pneumonia in Pregnancy is common cause of serious complications. Early detection, correct anti-infection therapy and proper supportive treatment brings favorable outcome. X-ray Chest, Sputum and Blood investigations are handy to define presence and severity of Pneumonia in Pregnancy
Presentation on Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis
References:
American Academy of Pediatrics. Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis, 2013.
American Academy of Pediatrics. Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis, 2012.
Pneumonia in pregnancy april2018 pmm_aogsParthiv Mehta
Pneumonia in Pregnancy is common cause of serious complications. Early detection, correct anti-infection therapy and proper supportive treatment brings favorable outcome. X-ray Chest, Sputum and Blood investigations are handy to define presence and severity of Pneumonia in Pregnancy
uti in children ,common infection in children,UTI managment ,different presentation of uti in children ,a neonate with UTI,how to preventUTI,neonate with poor feeding.common antibiotics used in UTI in children.investigation ofUTI.vesicoureteral reflex in children
Cryptosporidiosis in a young immunocompromised patientDr Shams Afridi
Cryptosporidium is a pathogen of significant public health issue especially in developing countries where water filtration and treatment is not up to the standards.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Empiric Antibiotic Management for Major Infections at MSKCC
1. September 18, 2013
Anna Kaltsas MD MS
Assistant Attending Physician
Infectious Diseases Service
2. Consults x7535
Green team: attending only
service
◦ Solid tumors, Ortho, GU,
Neurology
Blue team: attendings + ID
fellows
◦ Leukemia, lymphoma, ICU,
Pediatrics
Pharmacists – Antibiotic
Approval bpr 1100
Infection control – x7814
MSKCC guidelines on
intranet (“Reference manuals
and tutorials”)
3. Draw blood cultures first!!!
◦ Don’t forget UA, urine culture, CXR, C. difficile, LP if
indicated
◦ Work up for other source: ultrasound r/o DVT
◦ Not all fevers need empiric antibiotics!
Consider contact/respiratory isolation needs
Previous culture results
Allergies
What types of bacteria?
◦ Anatomic site
Oral/GI: mixed, anaerobes
Skin: GPC, ?viral
Lung: atypical, GPC;
HAP: GNR, anaerobes (aspiration)
Urine: GNR
4. Penicillin
◦ Most commonly reported
medication allergy – 10% of all
patients
◦ Anaphylaxis: 1-4 episodes/10,000
doses
◦ 85-90% found not to be truly
allergic (IgE mediated)
History of PCN “allergy”: only 0.17-
8.4% will react to cephalosporins
PCN allergy by skin test: 2% will react
to cephalosporins
Imipenem: 0-11% cross reactive
Aztreonam, quinolones: 0 cross
reactivity
Vancomycin/red man syndrome:
◦ histamine-mediated; rate
dependent infusion reaction.
◦ Not a true allergy!
Angioedema.
http://www.wellsphere.com/chronic-
pain-article/i-am-a-professional-
patient-part-two/624311
Drug rash.
http://www.riversideonline.com/source/ima
ges/image_popup/r7_drugrash.jpg
5. 250,000 cases
annually/80,000 in ICU
High hospital cost, patient
morbidity, 12-25% mortality
Suspect if tunnel/exit site
erythematous, has discharge,
or pt has fever without a
source.
CVC + PICC > tunneled
catheters and implanted ports
Sources for infection:
◦ Skin flora (extraluminal)
◦ Contamination from hubs/access
ports (intraluminal)
◦ Hematogenous/Infusion related
http://www.executivehm.com/article/Improve-
CRBSI-Prevention-Target-Intraluminal-Risks/
http://www.moffitt.org/moffittapps/ccj/v3n5/
dept6.html
6. Gram stain with GPC: Vancomycin
◦ Recent history of VRE: Linezolid
Gram stain with GNR: Zosyn or Cefepime
◦ Narrow to cephalosporin or oral quinolone when sensitivities are
back and repeat cultures are negative.
MSSA: oxacillin, nafcillin, cefazolin superior to
Vancomycin.
Yeast/Candida: Micafungin
◦ Pull line
◦ Optho consult (rule out endophthalmitis), TEE
Repeat blood cultures daily until negative x72 hours.
◦ If repeated cultures positive after 72 hours of appropriate
antibiotics, consider pulling line.
◦ If patient is sick/septic, consider pulling line.
Ok to replace central line/PICC when blood cultures clear
x72 hours.
7. O’Grady NP et al. Guidelines for the
prevention of intravascular catheter-
related infections. CID 2011:52.
Mermel LA et al. Clinical practice
guidelines for the diagnosis and
management of intravascular catheter-
related infections: 2009 update by the
Infectious Diseases Society of
America. CID 2009:49
8. Skin flora are common
contaminants
Coagulase-negative staphylococci
(S. epidermidis)
C. jeikeium, Bacillus, diptheroids
(gram positive bacilli)
Suspect contamination if single
culture from one lumen positive.
◦ All peripheral cx and other lumens
negative
◦ Pt/catheter looks well and has other
source for fever.
◦ Blood cx were drawn before
antibiotics.
S. aureus and Candida spp are
almost never contaminants!
Scanning EM; Bacteria
underneath human toenail.
http://resident-alien.blogspot.com/2007/07/humans-
wear-diverse-wardrobe-of-skin.html
9. UTI = most common nosocomial infection.
◦ 10-30% of catheterized patients develop bacteriuria.
10-25% of those with bacteriuria develop UTIs
Up to 80% of patients with cutaneous diversion of
urine through conduits develop bacteriuria and
chronic colonization.
◦ Stomal mucus, nephrostomy tubes, stents, catheters allow
for biofilm formation and propagation of bacterial growth.
◦ UTI/pyelonephritis can occur from stasis of urine, reflux of
urine, self catheterization techniques.
◦ PCN/stent obstruction or dislodgement:
Temporary blockage of the flow of (colonized urine) can result
in ascending infection, fever, bacteremia.
Symptoms: fever >38oC, suprapubic/CVA tenderness, SIRS
Diagnosis: urine cx >105 cfu/mL OR urine cx >103 cfu/mL with
pyuria on UA + above symptoms – on repeat specimen AFTER
changing foley
Warren J. Catheter-associated urinary tract infections.
Infect Dis Clin; 1997. 11(3):609-22.
Bruce AW et al. Bacterial adherence in the human ileal
conduit: a morphological and bacteriological study. J Urol.
1984 Jul;132(1):184-8.
10. UAs are unreliable in patients with
foley catheters, PCNs, ileal conduits.
◦ Change foley and repeat UA/urine culture
Ceftazidime, Cefepime, Zosyn
empirically
◦ Narrow once antibiotic sensitivities are
known
◦ Target initial antibiotics to past urine
culture results.
◦ High rate of GNR resistance to quinolones!
Enterococcus, CN staph, Candida are
often contaminants (perineal flora,
colonization of catheters).
Asymptomatic bacteriuria does not
have to be treated except in
pregnancy or before GU procedures.
In patients with GU hardware –
persistent fever/UTI sx despite
appropriate antibiotics is an indication
to replace stent/PCN!
http://www.theurologygroup.cc/images/Bladde
Replacement-7.gif
11. 8-15 cases/1,000 persons per year
Highest in winter months,
extremes of age
S. pneumoniae most common
world-wide
Suspect if: cough (productive),
fever, pleuritic chest pain, dyspnea
Following viral illness
High risk: >65, smokers, recent
chemo, neutropenia, intubated,
HIV/AIDS;
Post-obstructive PNA: lung
mass/met obstructing bronchus
Aspiration pneumonia:
◦ head and neck surgery
◦ speech/swallowing difficulties
◦ mental status changes
◦ Tube feeds/aspiration event! Right middle lobe pneumonia.
http://www.med-
ed.virginia.edu/courses/rad/cxr/pathology3ch
est.html
12. Does the patient need
respiratory isolation (viral,
TB)?
Work up:
◦ Chest Xray/CT Chest (non
contrast)
◦ Sputum cultures/deep tracheal
cultures if intubated
◦ Blood cultures
◦ If CAP: Legionella urine antigen,
S. pneumoniae urine antigen
◦ Viral nasal swab (automatic
droplet precautions)
◦ To rule out TB: sputum for AFB
x2, 24 hours apart
Gram positive diplococci on sputum gram stain.
http://drugster.info/img/ail/268_269_3.jpg
13. Inpatient, non ICU, CAP:
◦ Ceftriaxone 1gm IV daily x7d + Azithromycin 500
mg IV/po daily x5d
Aspiration PNA:
◦ Unasyn or Ceftriaxone + Flagyl
ICU, Hospital-acquired PNA, nursing home
resident:
◦ Zosyn 4.5 gm IV Q6h + Cefepime 2 gm IV Q12h
+/- Azithromycin 500 mg IV daily +/- Vancomycin
IV x5-7 days
◦ PCN allergy: Aztreonam + Flagyl; Imipenem
14. Infection extending beyond the
hollow viscus into previously
sterile peritoneal space.
◦ Cholecystitis, diverticulitis, bowel
anastomosis/surgery, typhlitis,
bowel obstruction…
>1000 species of gut bacteria;
more than 10 times the number
of cells in the human body!
◦ Abscess formation
◦ Peritonitis
Second most common cause of
infectious mortality in ICUs.
Appendicitis alone: 300,000
patients/year
Solomkin et al. Diagnosis and Management of Complicated
Intraabdominal Infections in Adults and Children: Guidelines by the
Surgical Infection Society and the Infectious Disease Society of
America. CID 2010:50
Free air.
http://www.wjgnet.com/1007-9327/full/v14/i24/WJG-
14-3922-g001.htm
15. Diagnosis: Physical exam, CT scan (po and IV contrast),
ultrasound (gall bladder).
◦ Signs of sepsis may be minimal in elderly or those on high-dose
steroids.
Draw blood cultures
Start appropriate antibiotics
◦ Cover GI flora: GNR, anaerobes, enterococcus, +/- Pseudomonas,
+/- Candida
◦ Cover organisms previously isolated in abscess drainages
◦ Culturing fluid in JP drains is low yield
Surgical or IR consult
◦ Mainstay of treatment for intra-abdominal abscess is surgical
drainage + antibiotics!
◦ Biliary stent change
◦ Treat for 10-14 days post drainage or until abscess resolved on
follow up imaging.
16. Unasyn, Zosyn, and Imipenem have anaerobic
coverage!
Spontaneous Bacterial Peritonitis
◦ Ceftriaxone 2gm IV daily
Bowel Perforation, Intraperitoneal abscess
◦ Include Pseudomonas coverage!
◦ Zosyn or Cefepime/Flagyl OR Cipro/Flagyl +/- Vancomycin
Diverticulitis
◦ Unasyn Or Cipro/Flagyl
Neutropenic Enterocolitis (Typhlitis)
◦ Include Pseudomonas coverage!
◦ Zosyn + Amikacin
Gall bladder (biliary sepsis, cholangitis, cholecystitis)
◦ Unasyn OR Ceftriaxone/Flagyl OR Ciprofloxacin/Flagyl
17. Gram positive anaerobic
bacillus; toxin producing.
Most common cause of
antibiotic-associated diarrhea in
the hospital.
◦ Diarrhea; colitis; toxic megacolon;
sepsis
20-30% recurrence rate; 1-2.5%
overall mortality; 25% mortality
in elderly or very infirm.
Cepheid GeneXpert PCR
platform 96%
sensitivity/specificity
Do not use as “test of cure” –
false positives
http://www.google.com/imgres?imgurl=http://www.health-
writings.com/img/uf/pseudomembranous-colitis-
symptoms/imgCdifficile4.jpg&imgrefurl
18. Initial episode, mild/moderate:
WBC <15, Cr <1.5:
◦ Flagyl 500 mg po Q8h
Initial episode, moderate or
severe, sepsis: WBC >15, Cr
>1.5
◦ Vancomycin 125 mg po Q6h
Unable to take po, ileus, toxic
megacolon:
Flagyl 500 mg IV Q8h + Vancomycin
po/PR
Second episode:
Same as initial therapy x14 days
Third or more episodes:
◦ Consider ID consult; prolonged
Vancomycin po taper
Toxic megacolon.
http://cueflash.com/decks/Pathology_Chapter_17_and_19_I
mages*
19. Commonly seen at MSK
Risk factors include
lymphadenectomies (axillary
LND – upper extremity
lymphedema; pelvic LND – lower
extremities), diabetes, PVD,
DVTs, chemotherapy, radiation
Beware venous stasis dermatitis!
Abscesses require I&D
Culture anything that’s draining
Blood cultures low yield unless
systemically ill
Antibiotics: Ancef 1gm IV q8h
◦ Vancomycin if PCN allergic or high
suspicion for MRSA
po options:
◦ Skin flora: Keflex, Cefadroxil
◦ MRSA: Clindamycin, Doxycycline,
Bactrim; Linezolid
Cellulitis in setting of
lymphedema.
http://www.acols.com/lymphedematoday/
Left leg cellulitis
http://odlarmed.com/wp-
content/uploads/2009/01/cellulitis_left_leg.jpg
20. Women with lymphedema have
10 times the risk of cellulitis
(Brewer et al, Risk factor analysis for breast cellulitis complicating breast
conservation therapy; Clin Infect Dis. (2000) 31 (3): 654-659.)
Skin flora, ?gram
negatives in seromas
Ancef -> po Cefadroxil
Vancomycin if PCN allergic
Consider adding
quinolone for gram
negative coverage if no
improvement, evidence for
infected seroma
Repeated infections or
history of S. aureus: may
need to remove
expander/implant.
Cellulitis with tissue expander.
http://www.realself.com/question/tissue-expander-
infection
21. “flesh eating disease;” can spread
through tissue at a rate of 3
cm/hour
25% mortality
Needs IMMEDIATE surgical
debridement
Polymicrobial; Group A strep
Bacteria introduced by minor
trauma
◦ Minor erythema, “pain out of
proportion to exam”
◦ Deep tissue infection, sepsis, shock
Fournier’s gangrene: NF of pelvic
area
ABX: Unasyn or Zosyn +
Vancomycin +/- Clindamycin
http://www.jyi.org/features/ft.php?id=463
22. Mortality 8-10% per episode
◦ Higher with liquid tumors, advanced age, multiple co-
morbidities
◦ Higher mortality: Gram negative bacteremia > gram
positive bacteremia
“GI” or “oral” source – mucositis, translocation of
bacteria across mucosa
Invasive fungal infections with prolonged neutropenia
Work up: Physical exam, CBC, chemistry, CXR or CT
Chest, blood cultures x2, UA/urine culture
MSKCC guidelines:
◦ Zosyn or Cefepime; OR Aztreonam + Vancomycin
◦ After 72 hours: add Vancomycin
◦ After 5-7 days add Ambisome
◦ Await count recovery!!
Kuderer et al. Mortality, morbidity, and
cost associated with febrile
neutropenia in adult cancer patients.
Cancer; 2006. 106(10):2258.